Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre.

Autor:	Ajmi SC; Department of Neurology, Stavanger University Hospital, Stavanger, Norway soffiena@yahoo.com.; Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway., Advani R; Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway., Fjetland L; Department of Radiology, Stavanger University Hospital, Stavanger, Norway., Kurz KD; Department of Radiology, Stavanger University Hospital, Stavanger, Norway.; Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway., Lindner T; Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.; Research, The Regional Centre for Emergency Medical Research and Development, Stavanger, Norway., Qvindesland SA; Research, Stavanger Acute Medicine Foundation for Education and Research, Stavanger, Norway., Ersdal H; Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.; Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway., Goyal M; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada., Kvaløy JT; Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.; Department of Research, University of Stavanger, Stavanger, Norway., Kurz M; Department of Neurology, Stavanger University Hospital, Stavanger, Norway.; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2019 Nov; Vol. 28 (11), pp. 939-948. Date of Electronic Publication: 2019 Jun 29.
DOI:	10.1136/bmjqs-2018-009117
Abstrakt:	Background: In eligible patients with acute ischaemic stroke, rapid revascularisation is crucial for good outcome. At our treatment centre, we had achieved and sustained a median door-to-needle time of under 30 min. We hypothesised that further improvement could be achieved through implementing a revised treatment protocol and in situ simulation-based team training sessions. This report describes a quality improvement project aiming to reduce door-to-needle times in stroke thrombolysis. Methods: All members of the acute stroke treatment team were surveyed to tailor the interventions to local conditions. Through a review of responses and available literature, the improvement team suggested changes to streamline the protocol and designed in situ simulation-based team training sessions. Implementation of interventions started in February 2017. We completed 14 simulation sessions from February to June 2017 and an additional 12 sessions from November 2017 to March 2018. Applying Kirkpatrick's four-level training evaluation model, participant reactions, clinical behaviour and patient outcomes were measured. Statistical process control charts were used to demonstrate changes in treatment times and patient outcomes. Results: A total of 650 consecutive patients, including a 3-year baseline, treated with intravenous thrombolysis were assessed. Median door to needle times were significantly reduced from 27 to 13 min and remained consistent after 13 months. Risk-adjusted cumulative sum charts indicate a reduced proportion of patients deceased or bedridden after 90 days. There was no significant change in balancing measures (stroke mimics, fatal intracranial haemorrhage and prehospital times). Conclusions: Implementing a revised treatment protocol in combination with in situ simulation-based team training sessions for stroke thrombolysis was followed by a considerable reduction in door-to-needle times and improved patient outcomes. Additional work is needed to assess sustainability and generalisability of the interventions. Competing Interests: Competing interests: SCA is a research fellow funded by a Safer Healthcare Grant (University Research Fund). MG has a consulting agreement with Mentice, the remaining authors report no disclosures. (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu